What are Oral Myofunctional Disorders
and how are they different from "tongue thrust"?
Although "tongue thrust" may
be used interchangeably with "Oral Myofunctional Disorder," there is a
difference between the two diagnoses or terms. Oral Myofunctional
Disorders (OMD's), are differences in the position or function of the muscles of
the face and/or mouth, including the lips and tongue. These differences in
dental, skeletal, and muscular structures may interfere with appropriate
swallowing, speech, and/or oral rest postures. At times, these often subtle differences may
also negatively impact dental and facial growth patterns. "Oral myofunctional
disorder" may be the preferred term since it includes the
concept of abnormal/incorrect tongue placement and lip movement for swallowing,
as well as labial and lingual rest posture differences, speech differences, oral
habits such as thumb/finger sucking, and structural abnormalities. "Tongue
thrust" refers to the improper placement and function of the tongue during
swallowing and is considered a specific category of Oral Myofunctional Disorder.
Why be concerned about oral
myofunctional disorders or 'tongue thrust'?
Dentists and orthodontists are concerned
with the effects of the tongue and facial muscles on the occlusion (how teeth
fit together) of teeth because of the evidence proving that too much tongue
pressure against the teeth on the inside and an unequal amount of facial muscle
pressure from the outside - as is the case with a tongue thrust swallow and/or
incorrect tongue resting posture - may result in in a malocclusion or
misalignment of the teeth. This is also true if the facial muscles are
stronger than those of the tongue - often the mentalis or chin muscle, is
over-active in the tongue thrust swallow/rest posture pattern and the lower
teeth may be tipped in as a result of the pull of this muscle. Orofacial
muscle function is not the result of the swallowing pattern alone however - the
resting posture of the tongue and facial muscles play an even more significant
role. If the tongue is constantly resting against the front teeth and the
upper lip in short or flaccid (weak and flabby), the front teeth will be pushed
forward.
In addition to negatively affecting
dentition and occlusion, other consequences of untreated oral myofunctional
disorders may include:
 |
articulation
errors |
|
increased
incidence of chronic sore throats, enlarged tonsils and upper respiratory
problems |
|
lowered
self-esteem because of the negative cosmetic and aesthetic results of an
improper mouth resting posture |
|
prolonged
wearing time for orthodontic appliances |
|
problems
wearing dentures in older adults |
What are some
possible causes of oral myofunctional disorders (OMD's) or 'tongue thrust'?
While no
specific cause has been determined for OMD's, many authorities believe that any
obstruction to the airway (such as enlarged tonsils or adenoids, or chronic
allergies) or an upper respiratory disorder, may contribute to the development
of an oral myofunctional disorder or tongue thrusting swallow pattern. It
is generally agreed among researchers in the field of orofacial myology and
orofacial myologists that any situation which forces the tongue out of its
preferred resting position, which is away from the teeth and resting against the
palate, may contribute to or encourage the development of an oral myofunctional
disorder and subsequent oral/facial muscle imbalance.
With this in
mind, possible causes may include:
|
Allergies |
|
Enlarged
tonsils and/or adenoids |
|
Short
lingual frenum |
|
Digit
(finger/thumb) or pacifier sucking beyond an appropriate age |
|
Neurological,
muscular, structural or other physiological abnormalities |
|
Hereditary
factors |
What are some
indicators of an oral myofunctional disorder?
One or more
of the following conditions may indicate an oral myofunctional disorder and
should be investigated further with an evaluation of oral muscle function by a
Certified Orofacial Myologist:
|
Frequent
mouth breathing in the absence of allergies or nasal congestion |
|
Frequent
open-mouth resting posture with the lips parted and/or the tongue resting
against the upper and/or lower teeth |
|
Lips
that are often cracked, chapped, and sore from frequent licking |
|
Tongue
protruding between or against the upper and/or lower "front
teeth" when forming /s/, /z/, /t/, /d/, /n/, /l/, or /sh/ |
|
Excess
tension in the area of the mentalis (chin muscle) when swallowing |
How are oral
myofunctional disorders corrected?
A treatment
approach known as oral myofunctional therapy has been shown to be
effective in correcting oral myofunctional disorders such as tongue thrust
swallow, improper tongue and mouth resting posture, improper use of muscles of
the mouth, tongue, and lips for chewing and swallowing, and late thumb/finger
sucking habits.
Oral
myofunctional therapy utilizes a team approach involving a certified orofacial
myologist, the orthodontist or general dentist, and if necessary, an
otolaryngologist (ENT physician) and Speech Pathologist. Oral myofunctional therapy has two main
goals:
|
establishing
an oral/facial resting posture with the tongue away from the teeth, against
the palate, and lips together |
|
establishing
oral, lingual, and facial muscle patterns which promote correct function of
these structures during drinking, and chewing, collecting and swallowing of
food. |
These goals
are accomplished by a series of exercises which focus first on retraining the
oral, lingual and facial muscles so that the correct rest postures may be
achieved; and then utilizing these new muscle patterns for habituating the
correct labial/lingual rest postures and correct chewing, collecting and
swallowing.
At what age
should oral myofunctional therapy begin?
Although
there are many diagnostic criteria that must be considered in the formulation
of an individuals treatment program - the age of the patient is not so
important as is the maturity level and motivation to succeed. Children as
young as four years of age may benefit from a diagnostic session to determine
if any preventative steps may be of benefit. Children seven or eight years of
age are often mature enough to successfully correct their oral myofunctional
disorder, and adults of any age are capable of success in their treatment. The
key is motivation to succeed and change their oral/facial muscle patterns!
Who is
qualified to correct oral myofunctional disorders?
Speech
pathologists, dentists, orthodontists, and dental hygienists are among specialists
who treat oral myofunctional disorders - however, all of these professionals
require training and experience beyond that received for their professional
degrees. The International Association of Orofacial Myology monitors courses
and training of professionals to assure that the highest standards of
professional skill and knowledge are maintained. Any person providing oral
myofunctional therapy should be certified by the International Association of
Orofacial Myology to assure that their knowledge and therapy techniques meet
these standards, and to assure that the patient receives quality treatment.
Tongue
Thrust Has Many Appearances
Anterior Tongue
Thrust
Anterior - Class 2 Tongue Thrust
Bilateral
- Anterior Tongue
Thrust
Bilateral Tongue Thrust
Class 3 Tongue
Thrust
Unilateral Tongue Thrust
(Photos copyright Academy of Myofunctional
Therapy - Sacramento, CA)
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